Surgical Procedures

By mixing different gases together, scientists can produce laser energy of varying wavelengths. scientists at IBM were experimenting back in the 1970's with different gas elements to create new lasers. They found that the 193-nanometer wavelength of the Argon-Fluoride excimer laser could remove molecules of corneal tissue with virtually no heat or damage to the surrounding tissue. This laser process was termed "Photoablation", meaning "vaporization through the use of laser light". This type of laser is used industrially to etch computer microchips because of the extremely fine precision and smoothness of the excimer laser beam. The excimer laser uses Argon and Fluoride gases mixed together in a high-voltage cavity to produce a cool (non-thermal) ultraviolet beam of light. Guided by a sophisticated computer, this light beam is then used to vaporize eye tissue by breaking molecular bonds. the excimer laser is so precise that each pulse can remove 39 millionths of an inch of tissue in 12 billionths of a second.

While we are proud of our statistics, meeting your expectations is our most important measure of success. During your pre-operative consultation we will assess your individual condition and provide you with your statistical chance of achieving a successful outcome, based upon our patient experience. This may facilitate your decision as to whether you should proceed with your refractive lasik surgery.

How is LASIK performed?
LASIK is a painless procedure performed in an outpatient setting with topical anesthesia. The eye drops are used to completely numb the eye but not the eyelids. The eyelids are held open with a small instrument to prevent blinking. The patient feels the sensation of the instruments around the lid area but does not feel any pain. A suction ring is placed on the eye and the patient feels a little pressure while the vision goes dim for a brief period of seconds. A microkeratome slides across the cornea in less than 15 seconds to create a thin lamellar corneal flap. After proper alignment, the high-energy pulses from the excimer laser are delivered to reshape the surface. By adjusting the pattern of the laser beam it is possible to treat myopia, hyperopia and astigmatism. After the laser treatment has obtained the proper contour the corneal flap is replaced in its original position. A protective eye shield is placed over the eye and worn for the first 12 to 24 hours as well as when sleeping for the next 3 to 4 days. The cornea has rapid healing qualities and no sutures are needed. However, fluctuation in vision and intermittent dry eyes are not uncommon for the first several weeks and months.
Postoperative recovery is quick and easy. Most patients feel minimal to no eye irritation during the first two hours and many patients see a dramatic improvement in vision by the first day. However, fluctuation in vision and intermittent dry eyes are not uncommon for the first several weeks.

What can I expect after LASIK?
Many patients are somewhat nervous before the procedure so a small dose of Valium is given to most patients to help take the edge off. This also relaxes you so that you are able to go right home and go to sleep, at least for a few hours. Don't expect your vision to be clear the first day. It's somewhat like looking under water. Since the flap is repositioned by floating back into place, a minor amount of swelling occurs. Plus, we protect your eyes with plastic shields which can also blur your vision. But, after a good nights rest, most patients are ecstatic with their new vision. You must then use antibiotic drops and mild steroid drops for the next few days and lubricating drops as needed for the dry eye feeling.

What about dry eyes after LASIK?
Dry eye symptoms are the most common complaint after LASIK. Everyone has dry eyes after LASIK surgery, but some notice it more than others. In this type of laser vision correction, a thin corneal flap is created on the surface of the eye. When the flap is made, the abundant supply of corneal nerves are also cut. This results in a partially anaesthetized corneal surface. It requires 3-6 months for these nerves to re-grow and provide the cornea normal sensation. As a result, the normal tear production is also interrupted and everyone experiences some degree of dryness, especially the first 2-4 weeks. There are numerous artificial tears and lubricating drops available as over-the-counter products. We initially recommend the preservative free products to prevent any unnecessary toxic response. But, as your eyes improve, switching to the more convenient bottles of preserved products is allowed. If the frequent use (at least every hour) of artificial tears does not improve your symptoms, then temporary or permanent closure of a tear duct can provide added relief. Since this is a temporary condition (3-6 months) in most cases, many patients do extremely well by simply lubricating their eyes with artificial tears.

How do I know if I need an enhancement?
The schedule of routine post-op visits includes a one day, two week and 3 month visit. Since the vision may fluctuate as the cornea heals, we recommend waiting a minimum of 3 months to reevaluate your visual results.
When we reevaluate, we look at such things as your vision without glasses & your prescription where we measure any residual astigmatism or mild over or under-correction. We ask about your night time driving and your reading vision. If your vision is not as good as you think it should be, and if there is a minor residual correction that can be treated with the laser, than an enhancement is discussed. Enhancement surgery is actually easier than the initial procedure because a flap is already present. In most cases, our surgeons simply identifies the edge and lifts up the original flap without cutting a new one. Because the cornea heals this layer very slowly, it can easily be lifted up to 1-2 years after surgery. In some instances a new flap is required and your surgeon can explain why it might be best in your particular situation. Either way, with LASIK touchup surgery is easy and usually requires much less laser energy to fine tune your vision. However, the healing process is the same and requires another 3 months to determine the final result.

Implantable Contact Lens (ICL)
LASIK is highly effective method of treating moderate amounts of myopia (nearsightedness) and low amounts of hyperopia (farsightedness), but is not effective for larger amounts of myopia or even moderate amounts of hyperopia. Clear Lensectomy, discussed elsewhere, is a viable alternative, particularly in the age group that requires bifocals or reading glasses. For those patients below the age of 40 however, a new alternative will shortly be available. This alternative is the "Implantable Contact Lens".

The Implantable Contact Lens or "ICL" is an extremely thin lens made of a new material called "Collamer". It is inserted surgically into the eye in a five minute procedure. It can be made in any power, therefore it can correct even extremely high amounts of refractive error.

We are watching the development of the ICLs. There the simplicity and reversal make this procedure promising.

Clear Lens Replacements
This procedure uses the same highly advanced technique practiced during routine cataract surgery. This accurate process involves the surgical removal of the clear, natural lens of the eye. It is then replaced with an artificial lens implant calculated specifically for the necessary amount of nearsightedness or farsightedness.

This surgery does involve a slightly greater degree of surgical intervention so it is usually reserved for those patients who do not fit the criteria for LASIK. These are patients with higher degrees of nearsightedness or farsightedness which are not safely treated with laser vision correction or those patients with early cataract changes.

Surgeons perform cataract procedures with artificial lens implantations that can correct both far and near vision , working best for those with advancing cataracts. The newest multifocal ReStor and ReZoom intraocular lens has allowed many patients minimal dependence on their spectacles. This exciting advancement in lens technology allows patients to see both distance and near, even for those patients over the age of forty who might otherwise need bifocals or reading glasses. One added benefit: these patients will never need cataract surgery since the natural lens that turns cloudy with a cataract has already been removed!